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Liu J, Zang C, Yi M, Zhang Y. Clinical Characteristics and Treatment Efficacy for Co-Morbid Insomnia and Sleep Apnea (COMISA): Evidence from Qualitative and Quantitative Analysis. Behav Sleep Med 2024; 22:611-635. [PMID: 38519143 DOI: 10.1080/15402002.2024.2324361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVES A multitude of physical and mental challenges are being faced in the population with Co-morbid Insomnia and Sleep Apnea (COMISA). Unfortunately, research about clinical characteristics and management of COMISA based on quantitative evidence is lacking. METHOD Standard procedures for literature retrieval, selection and quality assessment, data extraction, analysis, and interpretation were conducted step by step. For studying the sleep characteristics, common complications and widely recognized treatment options for COMISA, Weighted Mean Difference (WMD) and Odds Ratio (OR) were applied to assess the mean and risk differences between compared groups. Outcomes included sleep health parameters and secondary impairments in physical and mental well-being. RESULTS COMISA showed worse sleep quality than OSA only by PSQI (WMD = 3.38 point) and heavier sleep fragmentation (WMD = 11.46 min) than insomnia only. Besides, COMISA patients showed a higher risk for depression (OR [95%CI] = 5.03[2.31, 10.93]) and PTSD (OR [95%CI] = 3.96[1.85, 8.46]) in comparison with OSA alone. Compared to insomnia alone, COMISA patients suffered from more than two times higher risk of cardiovascular diseases, hypertension, and diabetes. In treating COMISA patients, combining CBTI with PAP treatment can enhance the improvement of insomnia severity (ISI, WMD [95%CI] =-3.26[-4.51, -2.00] point) and sleep efficiency (WMD [95%CI] = 6.39[1.97, 10.81] %) compared to PAP alone. CONCLUSIONS Impaired sleep domains in COMISA cover sleep quality and sleep structure. Also, COMISA has a higher risk for cardiometabolic diseases and mental disorders. Combining CBTI with PAP can be a recommended treatment to relieve sleep impairments for COMISA.
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Affiliation(s)
- Jie Liu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Chenyang Zang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Minhan Yi
- School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Yuan Zhang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Carney RM, Freedland KE, Rich MW. Treating Depression to Improve Survival in Coronary Heart Disease: What Have We Learned? J Am Coll Cardiol 2024; 84:482-489. [PMID: 39048281 DOI: 10.1016/j.jacc.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 07/27/2024]
Abstract
Major depressive disorder is a well-established risk factor for cardiac events in patients with coronary heart disease, but clinical trials have produced little evidence that treating depression reliably improves cardiac event-free survival in these patients. In this review, we offer evidence that certain symptoms that commonly remain after otherwise successful treatment of depression-insomnia, fatigue, and anhedonia-independently predict cardiac events. This may help to explain the failure of previous depression treatment trials to improve cardiac event-free survival even when other symptoms of depression improve. We thus propose that adverse cardiovascular effects that have long been attributed to syndromal depression may be instead caused by persistent fatigue, insomnia, and anhedonia, regardless of whether other symptoms of depression are present. We also identify interventions for these symptoms and call for more research to evaluate their effectiveness in depressed patients with coronary heart disease.
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Affiliation(s)
- Robert M Carney
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, USA.
| | - Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, USA
| | - Michael W Rich
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
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Mengin AC, Nourry N, Severac F, Berna F, Bemmouna D, Costache ME, Fritsch A, Frey I, Ligier F, Engel N, Greth P, Khan A, Chauvet-Gelinier JC, Chabridon G, Haffen E, Nicolier M, Zinetti-Bertschy A, Vidailhet P, Weiner L. Efficacy of the my health too online cognitive behavioral therapy program for healthcare workers during the COVID-19 pandemic: A randomized controlled trial. Internet Interv 2024; 36:100736. [PMID: 38617386 PMCID: PMC11015127 DOI: 10.1016/j.invent.2024.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/23/2024] [Accepted: 03/16/2024] [Indexed: 04/16/2024] Open
Abstract
Background Healthcare workers' mental health has been impacted by the COVID-19 pandemic, emphasizing the need for mental health interventions in this population. Online cognitive behavioral therapy (CBT) is efficient to reduce stress and may reach numerous professionals. We developed "MyHealthToo", an online CBT program to help reduce stress among healthcare workers during the COVID-19 pandemic. Objective The aim of our study is to investigate the efficacy of an online CBT program on stress and mental health conditions among healthcare workers during a health crisis. Methods We performed a multicentric randomized controlled trial among 155 participants allocated either to the experimental or active control group (bibliotherapy). The primary outcome was the decrease of perceived stress scores (PSS-10) post-treatment. Secondary outcomes included depression, insomnia and PTSD symptoms along with self-reported resilience and ruminations. Assessments were scheduled pretreatment, mid-treatment (4 weeks), post-treatment (8 weeks), and at 1-month and 4-months follow-up. Results For both interventions, mean changes on the PSS-10 were significant post-therapy (W8), as at 1-month (W12) and 4-months (W24) follow-ups. The between-group comparison showed no difference at any time point (ps > 0.88). Work-related ruminations significantly decreased in the experimental group with a significant between-group difference at W8 (Δ = -1.83 [-3.57; -0.09], p = 0.04). Posttraumatic stress symptoms significantly decreased in the experimental group with a significant between-group difference at W12 (Δ = -1.41 [-2.68; -0.14], p = 0.03). The decrease in work-related ruminations at W8 mediated the decrease in posttraumatic stress symptoms at W12 (p = 0.048). Conclusion The "MyHealthToo" online CBT intervention may help reduce ruminations about work and posttraumatic stress symptoms among healthcare workers during a major health crisis. Work-related ruminations may represent a relevant target of online interventions to improve mental health among healthcare workers.
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Affiliation(s)
- Amaury C. Mengin
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Regional Great East Center for Psychotraumatism, Strasbourg, France
- Strasbourg University, Faculty of Medicine, Strasbourg, France
- INSERM U1329, Strasbourg Translational NEuroscience and Psychiatry (STEP), Team Psychiatry, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, France
| | - Nathalie Nourry
- Strasbourg University, Faculty of Medicine, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Service de Pathologies Professionnelles et Médecine du Travail, Strasbourg, France
| | - François Severac
- Hôpitaux Universitaires de Strasbourg, Département de Santé Publique, GMRC, Strasbourg, France
- Université de Strasbourg, Laboratoire de Biostatistique et Informatique Médicale, iCUBE UMR, 7357 Illkirch, France
| | - Fabrice Berna
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Strasbourg University, Faculty of Medicine, Strasbourg, France
- INSERM U1329, Strasbourg Translational NEuroscience and Psychiatry (STEP), Team Psychiatry, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, France
| | - Doha Bemmouna
- Strasbourg University, Faculty of Psychology, Strasbourg, France
| | - Mădălina Elena Costache
- Strasbourg University, Faculty of Psychology, Strasbourg, France
- Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
| | - Aurélie Fritsch
- Strasbourg University, Faculty of Psychology, Strasbourg, France
- Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
| | - Isabelle Frey
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
| | - Fabienne Ligier
- PUPEA, Centre Psychothérapeutique de Nancy, Laxou; EA 4360 APEMAC, Université de Lorraine, Nancy, France
- Centre Psychothérapeutique de Nancy, Laxou, France
| | - Nadia Engel
- PUPEA, Centre Psychothérapeutique de Nancy, Laxou; EA 4360 APEMAC, Université de Lorraine, Nancy, France
- Centre Psychothérapeutique de Nancy, Laxou, France
| | - Philippe Greth
- Pôle de Psychiatrie et Santé Mentale du Groupe Hospitalier Mulhouse Sud Alsace, Mulhouse, France
| | - Anastasia Khan
- Pôle de Psychiatrie et Santé Mentale du Groupe Hospitalier Mulhouse Sud Alsace, Mulhouse, France
| | - Jean-Christophe Chauvet-Gelinier
- Service de Psychiatrie Adultes, Centre Hospitalier Universitaire Dijon-Bourgogne, Unité INSERM LNC-UMR 1231, Université de Bourgogne, Dijon, France
| | - Guillaume Chabridon
- Service de Psychiatrie Adultes, Centre Hospitalier Universitaire Dijon-Bourgogne, Unité INSERM LNC-UMR 1231, Université de Bourgogne, Dijon, France
| | - Emmanuel Haffen
- Service de Psychiatrie, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, Université Bourgogne-Franche-Comté, Besançon, France
| | - Magali Nicolier
- Service de Psychiatrie, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, Université Bourgogne-Franche-Comté, Besançon, France
| | - Anna Zinetti-Bertschy
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Strasbourg University, Faculty of Psychology, Strasbourg, France
| | - Pierre Vidailhet
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Regional Great East Center for Psychotraumatism, Strasbourg, France
- Strasbourg University, Faculty of Medicine, Strasbourg, France
- INSERM U1329, Strasbourg Translational NEuroscience and Psychiatry (STEP), Team Psychiatry, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, France
| | - Luisa Weiner
- Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France
- Strasbourg University, Faculty of Psychology, Strasbourg, France
- Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
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Yu J, Yang Z, Sun S, Sun K, Chen W, Zhang L, Xu J, Xu Q, Liu Z, Ke J, Zhang L, Zhu Y. The effect of weighted blankets on sleep and related disorders: a brief review. Front Psychiatry 2024; 15:1333015. [PMID: 38686123 PMCID: PMC11056563 DOI: 10.3389/fpsyt.2024.1333015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
Background Sleep disorders such as insomnia can lead to a range of health problems. The high risk of side effects and drug abuse of traditional pharmacotherapy calls for a safer non-pharmacotherapy. Aims To examine the use and efficacy of weighted blankets in improving sleep and related disorders in different populations and explore the possible mechanisms. Methods A literature search was conducted using PubMed, Embase, Web of Science, MEDLINE, Cochrane Library and CNKI databases. Eligible studies included an intervention with weighted blankets and outcomes covering sleep and/or related disorders (behavioral disturbance, negative emotions and daytime symptoms). Studies using other deep pressure, compression, or exercise-related interventions were excluded. Conclusions Most of the included studies showed that weighted blankets could effectively improve sleep quality and alleviate negative emotions and daytime symptoms in patients with sleep disorders, attention deficit hyperactivity disorder, autism spectrum disorder, and other related disorders, with a possible mechanism of deep pressure touch. Recommendations Weighted blankets might be a promising tool for sleep interventions among individuals with sleep disorders in clinical settings. More high-quality and large-scale randomized controlled trials are needed to further validate the safety and efficacy of weighted blankets and explore precise mechanisms.
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Affiliation(s)
- Jie Yu
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenqing Yang
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Sudan Sun
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Kaili Sun
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Weiran Chen
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Liming Zhang
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiahui Xu
- Department of Neurology/Center for Sleep Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qinglin Xu
- Department of Neurology/Center for Sleep Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zuyun Liu
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Juan Ke
- Department of Internal Medicine of Traditional Chinese Medicine, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing, China
| | - Lisan Zhang
- Department of Neurology/Center for Sleep Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yubo Zhu
- Department of Neurology, Affiliated Hospital of Shaoxing University, Shaoxing, China
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Thielecke J, Kuper P, Lehr D, Schuurmans L, Harrer M, Ebert DD, Cuijpers P, Behrendt D, Brückner H, Horvath H, Riper H, Buntrock C. Who benefits from indirect prevention and treatment of depression using an online intervention for insomnia? Results from an individual-participant data meta-analysis. Psychol Med 2024:1-14. [PMID: 38469832 DOI: 10.1017/s0033291724000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent and burdensome for individuals and society. While there are psychological interventions able to prevent and treat MDD, uptake remains low. To overcome structural and attitudinal barriers, an indirect approach of using online insomnia interventions seems promising because insomnia is less stigmatized, predicts MDD onset, is often comorbid and can outlast MDD treatment. This individual-participant-data meta-analysis evaluated the potential of the online insomnia intervention GET.ON Recovery as an indirect treatment to reduce depressive symptom severity (DSS) and potential MDD onset across a range of participant characteristics. METHODS Efficacy on depressive symptom outcomes was evaluated using multilevel regression models controlling for baseline severity. To identify potential effect moderators, clinical, sociodemographic, and work-related variables were investigated using univariable moderation and random-forest methodology before developing a multivariable decision tree. RESULTS IPD were obtained from four of seven eligible studies (N = 561); concentrating on workers with high work-stress. DSS was significantly lower in the intervention group both at post-assessment (d = -0.71 [95% CI-0.92 to -0.51]) and at follow-up (d = -0.84 [95% CI -1.11 to -0.57]). In the subsample (n = 121) without potential MDD at baseline, there were no significant group differences in onset of potential MDD. Moderation analyses revealed that effects on DSS differed significantly across baseline severity groups with effect sizes between d = -0.48 and -0.87 (post) and d = - 0.66 to -0.99 (follow-up), while no other sociodemographic, clinical, or work-related characteristics were significant moderators. CONCLUSIONS An online insomnia intervention is a promising approach to effectively reduce DSS in a preventive and treatment setting.
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Affiliation(s)
- Janika Thielecke
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Unit Healthy Living & Work, TNO (The Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | - Paula Kuper
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Dirk Lehr
- Department of Health Psychology and Applied Biological Psychology, Institute for Sustainability, Education & Psychology, Leuphana University Luneburg, Luneburg, Germany
| | - Lea Schuurmans
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Mathias Harrer
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
- GET.ON Institute for Online Health Trainings GmbH, Berlin, Germany
| | - David D Ebert
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, Netherlands
- Amsterdam Public Health, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Dörte Behrendt
- Department of Health Psychology and Applied Biological Psychology, Institute for Sustainability, Education & Psychology, Leuphana University Luneburg, Luneburg, Germany
| | - Hanna Brückner
- Department of Health Psychology and Applied Biological Psychology, Institute for Sustainability, Education & Psychology, Leuphana University Luneburg, Luneburg, Germany
| | - Hanne Horvath
- GET.ON Institute for Online Health Trainings GmbH, Berlin, Germany
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, Netherlands
- Amsterdam Public Health, Amsterdam University Medical Centers, Amsterdam, Netherlands
- Department of Psychiatry, VU University Medical Center, Amsterdam, Netherlands
| | - Claudia Buntrock
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Chung KF, Lee CT, Au CH, Kam KY, Lee CK, Yeung WF, Lau EYY, Ho FYY, Ho LM. Cognitive behavioural therapy for insomnia as an early intervention of mood disorders with comorbid insomnia: A randomized controlled trial. Early Interv Psychiatry 2024; 18:82-93. [PMID: 37192756 DOI: 10.1111/eip.13435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/30/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of small-group nurse-administered cognitive behavioural therapy for insomnia (CBTI) as an early intervention of mood disorders with comorbid insomnia. METHODS A total of 200 patients with first-episode depressive or bipolar disorders and comorbid insomnia were randomized in a ratio of 1:1 to receiving 4-session CBTI or not in a routine psychiatric care setting. Primary outcome was Insomnia Severity Index. Secondary outcomes included response and remission status; daytime symptomatology and quality of life; medication burden; sleep-related cognitions and behaviours; and the credibility, satisfaction, adherence and adverse events of CBTI. Assessments were conducted at baseline, 3, 6, and 12-month. RESULTS Only a significant time-effect but no group-by-time interaction was found in the primary outcome. Several secondary outcomes had significantly greater improvements in CBTI group, including higher depression remission at 12-month (59.7% vs. 37.9%, χ2 = 6.57, p = .01), lower anxiolytic use at 3-month (18.1% vs. 33.3%, χ2 = 4.72, p = .03) and 12-month (12.5% vs. 25.8%, χ2 = 3.26, p = .047), and lesser sleep-related dysfunctional cognitions at 3 and 6-month (mixed-effects model, F = 5.12, p = .001 and .03, respectively). Depression remission rate was 28.6%, 40.3%, and 59.7% at 3, 6, and 12-month, respectively in CBTI group and 28.4%, 31.1%, and 37.9%, respectively in no CBTI group. CONCLUSION CBTI may be a useful early intervention to enhance depression remission and reduce medication burden in patients with first-episode depressive disorder and comorbid insomnia.
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Affiliation(s)
- Ka-Fai Chung
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Chit-Tat Lee
- Department of Psychiatry, Queen Mary Hospital, Hong Kong, China
| | - Chi-Hung Au
- Department of Psychiatry, Queen Mary Hospital, Hong Kong, China
| | - Ka-Yee Kam
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Che-Kin Lee
- Department of Psychiatry, Kowloon Hospital, Hong Kong, China
| | - Wing-Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Esther Yuet Ying Lau
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Lai-Ming Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
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Blom K, Forsell E, Hellberg M, Svanborg C, Jernelöv S, Kaldo V. Psychological Treatment of Comorbid Insomnia and Depression: A Double-Blind Randomized Placebo-Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:100-113. [PMID: 38286128 PMCID: PMC10997274 DOI: 10.1159/000536063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Insomnia and depression are highly prevalent disorders and commonly occur together. Cognitive behavioral therapy for insomnia, CBT-I, has been shown to be effective in treating insomnia and also comorbid depression. However, it is unclear whether effects of CBT-I on depression are specific or nonspecific. Also, depressive symptoms often remain too high after CBT-I, indicating a need for improved treatments. The objective was to determine whether combining CBT-I with CBT for depression, without increasing treatment length, reduces both insomnia and depression more than CBT for depression with a placebo insomnia intervention. METHODS A 12-week double-blind randomized controlled trial with a 6-month follow-up in a psychiatric setting using therapist-guided internet-delivered treatments was conducted. Patients (N = 126) were diagnosed with insomnia disorder and major depression by physicians. Primary outcome measures were as follows: self-rating scales Insomnia Severity Index (ISI) and Montgomery-Åsberg Depression Rating Scale (MADRS-S). RESULTS The combined treatment showed specific effects on insomnia severity over the control treatment (p = 0.007) but was not more effective in reducing depression severity. Within-group effects (Cohen's d) at post and at 6 months were as follows: ISI 1.40 and 1.42 (combined treatment), 0.95 and 1.00 (control); MADRS-S 0.97 and 1.12 (combined), 0.88 and 0.89 (control). CONCLUSIONS CBT-I shows large specific effects on insomnia severity and is superior to control in this regard. Both treatments had similar effects on depression severity, i.e., combining CBT-I with CBT for depression did not enhance outcomes on depression compared to control. We suggest CBT-I should always be offered to patients with insomnia and depression comorbidity, possibly as the first-hand choice. Combining it with a psychological treatment for depression could be too burdening and may not be beneficial.
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Affiliation(s)
- Kerstin Blom
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Erik Forsell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Monica Hellberg
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Cecilia Svanborg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Susanna Jernelöv
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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8
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Leerssen J, Aghajani M, Bresser T, Rösler L, Winkler AM, Foster-Dingley JC, Van Someren EJW. Cognitive, Behavioral, and Circadian Rhythm Interventions for Insomnia Alter Emotional Brain Responses. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:60-69. [PMID: 36958474 DOI: 10.1016/j.bpsc.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND The highest risk of depression is conveyed by insomnia. This risk can be mitigated by sleep interventions. Understanding brain mechanisms underlying increased emotional stability following insomnia treatment could provide insight relevant to the prevention of depression. Here, we investigated how different sleep interventions alter emotion-related brain activity in people with insomnia at high risk of developing depression. METHODS Functional magnetic resonance imaging was used to assess how the amygdala response to emotional stimuli (negative facial expression) in 122 people with insomnia disorder differed from 36 control subjects and how the amygdala response changed after 6 weeks of either no treatment or internet-based circadian rhythm support (CRS), cognitive behavioral therapy for insomnia (CBT-I), or their combination (CBT-I+CRS). Effects on depression, insomnia and anxiety severity were followed up for 1 year. RESULTS Only combined treatment (CBT-I+CRS) significantly increased the amygdala response, compared with no treatment, CBT-I, and CRS. Individual differences in the degree of response enhancement were associated with improvement of insomnia symptoms directly after treatment (r = -0.41, p = .021). Moreover, exclusively CBT-I+CRS enhanced responsiveness of the left insula, which occurred in proportion to the reduction in depressive symptom severity (r = -0.37, p = .042). CONCLUSIONS This functional magnetic resonance imaging study on insomnia treatment, the largest to date, shows that a combined cognitive, behavioral, and circadian intervention enhances emotional brain responsiveness and might improve resilience in patients with insomnia who are at high risk of developing depression.
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Affiliation(s)
- Jeanne Leerssen
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands.
| | - Moji Aghajani
- Section Forensic Family and Youth Care, Institute of Education and Child Studies, Leiden University, Leiden, the Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Tom Bresser
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands; Department of Clinical Genetics, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Lara Rösler
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Anderson M Winkler
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Jessica C Foster-Dingley
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, VU University, Amsterdam, the Netherlands
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9
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Harrington MO, Reeve S, Bower JL, Renoult L. How do the sleep features that characterise depression impact memory? Emerg Top Life Sci 2023; 7:499-512. [PMID: 38054537 PMCID: PMC10754336 DOI: 10.1042/etls20230100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023]
Abstract
Depression is associated with general sleep disturbance and abnormalities in sleep physiology. For example, compared with control subjects, depressed patients exhibit lower sleep efficiency, longer rapid eye movement (REM) sleep duration, and diminished slow-wave activity during non-REM sleep. A separate literature indicates that depression is also associated with many distinguishing memory characteristics, including emotional memory bias, overgeneral autobiographical memory, and impaired memory suppression. The sleep and memory features that hallmark depression may both contribute to the onset and maintenance of the disorder. Despite our rapidly growing understanding of the intimate relationship between sleep and memory, our comprehension of how sleep and memory interact in the aetiology of depression remains poor. In this narrative review, we consider how the sleep signatures of depression could contribute to the accompanying memory characteristics.
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Affiliation(s)
| | - Sarah Reeve
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, U.K
| | - Joanne L. Bower
- School of Psychology, University of East Anglia, Norwich, U.K
| | - Louis Renoult
- School of Psychology, University of East Anglia, Norwich, U.K
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10
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Hertenstein E, Benz F, Schneider CL, Baglioni C. Insomnia-A risk factor for mental disorders. J Sleep Res 2023; 32:e13930. [PMID: 37211915 DOI: 10.1111/jsr.13930] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/23/2023]
Abstract
Longitudinal studies observed that individuals suffering from insomnia disorder have a higher vulnerability to develop symptoms of psychopathology compared with good sleepers. Particularly, insomnia disorder has been associated with an increased risk for depression. Previous studies indicate relatively stable effects; however, replication is needed as the last meta-analysis on the topic has been published 4 years ago. We conducted a replication of a previous systematic review and meta-analysis evaluating the longitudinal association between insomnia disorder and psychopathology, including original works published between 2018 and 2022. Literature search was conducted from April 2018 to August 2022 using key words identifying longitudinal studies that evaluate individuals with insomnia disorder compared with good sleepers at baseline, and the onset of all possible mental disorders at long-term follow-up. Only one work was added to the previous sample of studies published in 2019 looking at the longitudinal association between insomnia disorder and depression. Meta-analytic results confirmed the previous observation, with an even higher observed effect for the link between insomnia and depression. This again recognizes insomnia disorder as a possible transdiagnostic process in psychopathology, with consequent important clinical implications. Nevertheless, more longitudinal studies are needed evaluating the link between insomnia disorder and mental disorders.
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Affiliation(s)
- Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Geneva, Geneva, Switzerland
| | - Fee Benz
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine University of Freiburg, Freiburg, Germany
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Chiara Baglioni
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine University of Freiburg, Freiburg, Germany
- Department of Human Sciences, University of Rome 'G. Marconi'-Telematic, Rome, Italy
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11
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Reffi AN, Cheng P. Healthy sleep may bolster resilience to depression and posttraumatic stress disorder in new paramedics. Sleep 2023; 46:zsad064. [PMID: 36883766 DOI: 10.1093/sleep/zsad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 03/09/2023] Open
Affiliation(s)
- Anthony N Reffi
- Division of Sleep Medicine, Thomas Roth Sleep Disorders & Research Center, Henry Ford Health, Detroit, MI, USA
| | - Philip Cheng
- Division of Sleep Medicine, Thomas Roth Sleep Disorders & Research Center, Henry Ford Health, Detroit, MI, USA
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12
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Cheng P, Kalmbach DA, Hsieh HF, Castelan AC, Sagong C, Drake CL. Improved resilience following digital cognitive behavioral therapy for insomnia protects against insomnia and depression one year later. Psychol Med 2023; 53:3826-3836. [PMID: 35257648 PMCID: PMC9452602 DOI: 10.1017/s0033291722000472] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/25/2022] [Accepted: 02/09/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND While the negative consequences of insomnia are well-documented, a strengths-based understanding of how sleep can increase health promotion is still emerging and much-needed. Correlational evidence has connected sleep and insomnia to resilience; however, this relationship has not yet been experimentally tested. This study examined resilience as a mediator of treatment outcomes in a randomized clinical trial with insomnia patients. METHODS Participants were randomized to either digital cognitive behavioral therapy for insomnia (dCBT-I; n = 358) or sleep education control (n = 300), and assessed at pre-treatment, post-treatment, and 1-year follow-up. A structural equation modeling framework was utilized to test resilience as a mediator of insomnia and depression. Risk for insomnia and depression was also tested in the model, operationalized as a latent factor with sleep reactivity, stress, and rumination as indicators (aligned with the 3-P model). Sensitivity analyses tested the impact of change in resilience on the insomnia relapse and incident depression at 1-year follow-up. RESULTS dCBT-I resulted in greater improvements in resilience compared to the sleep education control. Furthermore, improved resilience following dCBT-I lowered latent risk, which was further associated with reduced insomnia and depression at 1-year follow-up. Sensitivity analyses indicated that each point improvement in resilience following treatment reduced the odds of insomnia relapse and incident depression 1 year later by 76% and 65%, respectively. CONCLUSIONS Improved resilience is likely a contributing mechanism to treatment gains following insomnia therapy, which may then reduce longer-term risk for insomnia relapse and depression.
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Affiliation(s)
- Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, 39450 W 12 Mile Road, Novi, MI 48197, USA
| | - David A. Kalmbach
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, 39450 W 12 Mile Road, Novi, MI 48197, USA
| | - Hsing-Fang Hsieh
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Andrea Cuamatzi Castelan
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, 39450 W 12 Mile Road, Novi, MI 48197, USA
| | - Chaewon Sagong
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, 39450 W 12 Mile Road, Novi, MI 48197, USA
| | - Christopher L. Drake
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, 39450 W 12 Mile Road, Novi, MI 48197, USA
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13
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Saunders R, Liu Y, Delamain H, O'Driscoll C, Naqvi SA, Singh S, Stott J, Wheatley J, Pilling S, Cape J, Buckman JEJ. Examining bi-directional change in sleep and depression symptoms in individuals receiving routine psychological treatment. J Psychiatr Res 2023; 163:1-8. [PMID: 37178582 PMCID: PMC10643991 DOI: 10.1016/j.jpsychires.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/03/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Sleep disturbance is a common symptom of depression. There is conflicting evidence whether improvements in sleep might impact depressive symptoms, or whether treating the core depressive symptoms might improve sleep disturbance. This study explored the bi-directional impact of sleep and depressive symptom change among individuals receiving psychological treatment. METHODS Session-by-session change in sleep disturbance and depressive symptom severity scores were explored in patients receiving psychological therapy for depression from Improving Access to Psychological Therapies services in England. Bi-directional change in sleep disturbance and depressive symptoms was modelled using random-intercept cross-lagged panel models with items from the PHQ-9. RESULTS The sample included 17,732 adults that had received three or more treatment sessions. Both depressive symptoms and sleep disturbance scores decreased. Between initial timepoints, higher sleep disturbance was associated with lower depression scores, but after this point positive cross-lagged effects were observed for both the impact of sleep disturbance on later depressive symptoms, and depressive symptoms on later sleep disturbance scores. The magnitude of effects suggested depressive symptoms may have more impact on sleep than the reverse, and this effect was larger in sensitivity analyses. CONCLUSIONS Findings provide evidence that psychological therapy for depression results in improvements in core depressive symptoms and sleep disturbance. There was some evidence that depressive symptoms may have more impact on sleep disturbance scores at the next therapy session, than sleep disturbance does on later depressive symptoms. Targeting the core symptoms of depression initially may optimise outcomes, but further research is needed to elucidate these relationships.
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Affiliation(s)
- R Saunders
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom.
| | - Y Liu
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom
| | - H Delamain
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom
| | - C O'Driscoll
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom
| | - S A Naqvi
- Barking & Dagenham and Havering IAPT Services - North East London NHS Foundation Trust, London, United Kingdom
| | - S Singh
- Waltham Forest Talking Therapies - North East London NHS Foundation Trust, London, United Kingdom
| | - J Stott
- ADAPTlab, Research Department of Clinical Educational and Health Psychology, UCL, London, United Kingdom
| | - J Wheatley
- Talk Changes: City & Hackney IAPT Service - Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | - S Pilling
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom; Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - J Cape
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom
| | - J E J Buckman
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom; iCope -Camden and Islington Psychological Therapies Services - Camden & Islington NHS Foundation Trust, London, United Kingdom
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14
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Boland EM, Goldschmied JR, Gehrman PR. Does insomnia treatment prevent depression? Sleep 2023; 46:zsad104. [PMID: 37029781 PMCID: PMC10262035 DOI: 10.1093/sleep/zsad104] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/21/2023] [Indexed: 04/09/2023] Open
Abstract
Rates of major depressive disorder (MDD) are increasing globally, in part due to the coronavirus disease 2019 pandemic, contributing to disease burden. It has long been known that insomnia is intricately connected with depression as indicated by greater depression severity and lower treatment response. Furthermore, insomnia is a significant risk factor for new-onset depression. Treatment of insomnia is thus a logical target for prevention of incidents and recurrent MDD. This systematic review sought to evaluate the current evidence for the preventive effects of insomnia treatment on depression onset. A database search yielded 186 studies, six of which met criteria for inclusion in this review. All of the studies utilized cognitive behavioral treatment for insomnia (CBT-I) as the target intervention and most delivered treatment via a digital platform. Four of the studies found significantly lower rates of MDD onset in those who received CBT-I compared to a control condition. The two remaining studies failed to confirm these effects in primary analyses but secondary analyses suggested evidence of a preventive effect. There was significant methodologic heterogeneity across studies in terms of sample selection, outcomes, and follow-up periods, limiting the ability to draw firm conclusions. The evidence overall is in the direction of insomnia treatment reducing the risk for onset of MDD, but further research is warranted.
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Affiliation(s)
- Elaine M Boland
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Cpl. Michael J. Crescenz VA Medical Center, Mental Illness Research Education and Clinical Center, Philadelphia, PA, USA
| | - Jennifer R Goldschmied
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Philip R Gehrman
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Cpl. Michael J. Crescenz VA Medical Center, Mental Illness Research Education and Clinical Center, Philadelphia, PA, USA
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15
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Zhang C, Zeng S, Xu Y, Liu S, Du S, Fang L, Lv Z, Zhang L, Zhang B. Baseline symptoms of depression and anxiety negatively impact the effectiveness of CBTi in treating acute insomnia among young adults. Gen Psychiatr 2023; 36:e101013. [PMID: 37265474 PMCID: PMC10230965 DOI: 10.1136/gpsych-2023-101013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/17/2023] [Indexed: 06/03/2023] Open
Abstract
Background Cognitive-behavioural therapy for insomnia (CBTi) is the first-line treatment for those with this sleep disorder. However, depressive and anxiety symptoms often co-occur with acute insomnia, which may affect the effectiveness of CBTi treatment. Aims This study aimed to determine the impact of depressive and anxiety symptoms on the efficacy of CBTi in treating acute insomnia. Methods A single-arm clinical trial was conducted among individuals who have acute insomnia. Participants underwent self-guided CBTi for 1-week. Their insomnia, depressive symptoms and anxiety symptoms were evaluated using the Insomnia Severity Index and the Hospital Anxiety and Depression Scale at baseline, post-treatment and 3-month follow-up. Repeated measures analysis of variance was used to assess the effectiveness of CBTi in treating insomnia, depressive symptoms and anxiety symptoms. A multivariate Cox regression model was used to determine the impact of depressive and anxiety symptoms on insomnia. Results The study found significant reductions in insomnia, depressive symptoms and anxiety symptoms at both post-treatment and 3-month follow-up (F=17.45, p<0.001; F=36.37, p=0.001; and F=81.51, p<0.001, respectively). The duration of CBTi treatment had a positive impact on insomnia recovery (hazard ratio (HR)=0.94, p=0.018). However, baseline depressive symptoms (HR=1.83, p=0.004) and baseline anxiety symptoms (HR=1.99, p=0.001) had significant negative effects on insomnia recovery. Conclusions The study showed that a 1-week self-guided CBTi treatment is effective in treating acute insomnia and comorbid depressive and anxiety symptoms. However, baseline depressive and anxiety symptoms negatively impact treatment effectiveness. Therefore, clinicians should assess for depressive and anxiety symptoms before treating acute insomnia with monotherapy CBTi.
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Affiliation(s)
- Chenxi Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shufei Zeng
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Xu
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shuai Liu
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shixu Du
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Leqin Fang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhihong Lv
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lili Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
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16
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Edge D, Watkins ER, Limond J, Mugadza J. The efficacy of self-guided internet and mobile-based interventions for preventing anxiety and depression - A systematic review and meta-analysis. Behav Res Ther 2023; 164:104292. [PMID: 37003138 DOI: 10.1016/j.brat.2023.104292] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Anxiety and depression are highly prevalent mental disorders which are associated with a considerable personal and economic burden. As treatment alone has a minimal impact on prevalence, there is now a growing focus on interventions which may help prevent anxiety and depression. Internet and mobile based interventions have been identified as a useful avenue for the delivery of preventative programmes due to their scalability and accessibility. The efficacy of interventions that do not require additional support from a trained professional (self-guided) in this capacity is yet to be explored. METHOD A systematic search was conducted on the Cochrane Library, PubMed, PsycARTICLES, PsycINFO, OVID, MEDline, PsycEXTRA and SCOPUS databases. Studies were selected according to defined inclusion and exclusion criteria. The primary outcome was evaluating the effect of self-guided internet and mobile based interventions on incidence of anxiety and depression. The secondary outcome was effect on symptom severity. RESULTS After identifying and removing duplicates, 3211 studies were screened, 32 of which were eligible for inclusion in the final analysis. Nine studies also reported incidence data (depression = 7, anxiety = 2). The overall Risk Ratios for incidence of anxiety and depression were 0.86 (95% CI [0.28, 2.66], p = .79) and 0.67 (95% CI [0.48, 0.93], p = .02) respectively. Analysis for 27 studies reporting severity of depressive symptoms revealed a significant posttreatment standardised mean difference of -0.27 (95% CI [ -0.37, -0.17], p < .001) for self-guided intervention groups relative to controls. A similar result was observed for 29 studies reporting severity of anxiety symptoms with a standardised mean difference of -0.21 (95% CI [-0.31, -0.10], p < .001). CONCLUSIONS Self-guided internet and mobile based interventions appear to be effective at preventing incidence of depression, though further examination of the data suggests that generalisability of this finding may be limited. While self-guided interventions also appear effective in reducing symptoms of anxiety and depression, their ability to prevent incidence of anxiety is less clear. A heavy reliance on symptom measures in the data analysed suggests future research could benefit from prioritising the use of standardised diagnostic measuring tools to assess incidence. Future systematic reviews should aim to include more data from grey literature and reduce the impact of study heterogeneity.
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Affiliation(s)
- Daniel Edge
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom.
| | - Edward R Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom
| | - Jenny Limond
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom
| | - Jane Mugadza
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom
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17
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Mathews A, Gibbons N, Harrison E, C Ukoumunne O, Stallard P. A feasibility study to explore the use of digital treatment of sleep as a first-step intervention to improve adolescent mental health. Behav Sleep Med 2023; 21:172-184. [PMID: 35435785 DOI: 10.1080/15402002.2022.2063866] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Cognitive behavior therapy for insomnia (CBTi), delivered face-to-face or digitally, can improve the mental health of adults. Although insomnia is common in adolescents, the effects of digital CBTi on adolescent mental health have seldom been investigated. OBJECTIVES The aims of this study were to explore: (i) the acceptability of a digital CBTi intervention, Sleepio, as a first-step intervention for adolescents referred to specialist mental health services (CAMHS), (ii) the impact on sleep and mental health and (iii) subsequent CAMHS interventions. METHOD Sleepio is a computerized CBTi intervention comprised of six sequentially delivered sessions. Digital Sleepio was offered to new referrals to CAMHS with poor sleep and mental health problems. Results. Of the 75 eligible adolescents, 70 (93%; 95% CI: 85% to 98%) accepted Sleepio with 59 starting the programme and consenting to participate in the study. Of these, 37 (63%; 95% CI: 49% to 75%) completed at least half of the programme. There were post-intervention improvements in sleep, mood, and anxiety; the improvement in sleep was greater for those who completed at least half the programme compared to those who did not. Of those who completed all the programme, 55% (15/29) did not need any subsequent specialist CAMHS input. Of the 11 adolescents who accepted but never started Sleepio, none engaged with other CAMHS interventions and were subsequently discharged. CONCLUSION Our study has a number of limitations, in particular the absence of a control group and the loss of follow-up data for programme drop-outs. Nonetheless, these results suggest that digital CBTi may offer a novel and acceptable way of improving the sleep and mental health of adolescents with insomnia. A fully powered randomized controlled trial is required to obtain definitive estimates of the effects of the intervention.
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Affiliation(s)
| | - Naomi Gibbons
- Oxford Health NHS Foundation Trust, Child and Adolescent Mental Health Services
| | - Emma Harrison
- Oxford Health NHS Foundation Trust, Child and Adolescent Mental Health Services
| | | | - Paul Stallard
- Department of Health, University of Bath, Bath, UK.,Oxford Health NHS Foundation Trust, Child and Adolescent Mental Health Services
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18
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Do better nights lead to better days? Guided internet-based cognitive behavioral therapy for insomnia in people suffering from a range of mental health problems: Protocol of a pragmatic randomized clinical trial. Contemp Clin Trials 2023; 127:107122. [PMID: 36813085 DOI: 10.1016/j.cct.2023.107122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Insomnia is the transdiagnostically shared most common complaint in disorders of anxiety, stress and emotion regulation. Current cognitive behavioral therapies (CBT) for these disorders do not address sleep, while good sleep is essential for regulating emotions and learning new cognitions and behaviours: the core fundaments of CBT. This transdiagnostic randomized control trial (RCT) evaluates whether guided internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) (1) improves sleep, (2) affects the progression of emotional distress and (3) enhances the effectiveness of regular treatment of people with clinically relevant symptoms of emotional disorders across all mental health care (MHC) echelons. METHODS We aim for 576 completers with clinically relevant symptoms of insomnia as well as at least one of the dimensions of generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD), posttraumatic stress disorder (PTSD) or borderline personality disorder (BPD). Participants are either pre-clinical, unattended, or referred to general- or specialized MHC. Using covariate-adaptive randomization, participants will be assigned to a 5 to 8-week iCBT-I (i-Sleep) or a control condition (sleep diary only) and assessed at baseline, and after two and eight months. The primary outcome is insomnia severity. Secondary outcomes address sleep, severity of mental health symptoms, daytime functioning, mental health protective lifestyles, well-being, and process evaluation measures. Analyses use linear mixed-effect regression models. DISCUSSION This study can reveal for whom, and at which stage of disease progression, better nights could mean substantially better days. TRIAL REGISTRATION International Clinical Trial Registry Platform (NL9776). Registered on 2021-10-07.
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19
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Yao Y, Lin M, Ni J, Ni J. Hope Buffers the Effect of Fear of COVID-19 on Depression among College Students: Insomnia as a Mediator. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3245. [PMID: 36833940 PMCID: PMC9966876 DOI: 10.3390/ijerph20043245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/07/2023] [Accepted: 02/11/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND In the period of the global pandemic, psychophysical problems induced by the fear of COVID-19 among college students deserve attention since the dormitory environment in college greatly increases the possibility of COVID-19 infection. METHODS A hypothesized mediated moderation model was to be verified using a cross-sectional study among 2453 college students. Fear of COVID-19, insomnia, hope, and depression were assessed by using the relevant scales. RESULTS (1) The fear of COVID-19 was positively correlated to depression (β = 0.365, t = 5.553, 95% CI = [0.236, 0.494]); (2) hope moderated the influence of the fear of COVID-19 on depression (β = -0.093, t = -4.066, 95% CI = [-0.137, -0.048]), as well as on insomnia (β = -0.095, t = -4.841, 95% CI = [-0.133, -0.056]); and (3) the mediated moderation model with hope as the moderator and insomnia as the full mediating variable between fear of COVID-19 and depression was verified (β = -0.060, 95% CI = [-0.093, -0.028]). CONCLUSIONS The findings suggest that hope is a vital mechanism to explain the relationship between the fear of COVID-19 and depression in early adulthood. In practical application, mental health practitioners should focus on boosting hope and alleviating insomnia when addressing COVID-19-related depression issues among college students.
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Affiliation(s)
- Yingying Yao
- Counseling and Education Center, Xiamen University, Xiamen 361005, China
| | - Min Lin
- Institute of Education, Xiamen University, Xiamen 361005, China
| | - Jianchao Ni
- School of Aerospace Engineering, Xiamen University, Xiamen 361005, China
| | - Jing Ni
- Faculty of Nursing, Jiujiang University, Jiujiang 332005, China
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20
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Kalmbach DA, Cheng P. Embracing telemedicine and digital delivery of cognitive-behavioral therapy for insomnia: where do we come from and where are we going? Sleep 2023; 46:zsac291. [PMID: 36455233 DOI: 10.1093/sleep/zsac291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- David A Kalmbach
- Division of Sleep Medicine, Thomas Roth Sleep Disorders & Research Center, Henry Ford Health, Detroit, MI, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Philip Cheng
- Division of Sleep Medicine, Thomas Roth Sleep Disorders & Research Center, Henry Ford Health, Detroit, MI, USA
- Department of Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
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Mojsa-Kaja J, Szklarczyk-Smolana K, Niedzielska-Andres E, Kurpińska A, Suraj-Prażmowska J, Walczak M. COVID-19-related social isolation and symptoms of depression and anxiety in young men in Poland: Does insomnia mediate the relationship? PLoS One 2023; 18:e0285797. [PMID: 37200255 DOI: 10.1371/journal.pone.0285797] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/29/2023] [Indexed: 05/20/2023] Open
Abstract
The need for physical distancing due to COVID-19 mitigation efforts forced prolonged social isolation, which may affect sleep and lead to mental health problems. Previous research has shown that young adults are particularly vulnerable to psychological stress caused by social isolation, the negative psychological impact of the pandemic, and greater frequency and severity of sleep problems. Therefore, the main goal of the present study was to examine whether insomnia could constitute a mediation mechanism that explains the relationship between social isolation experienced during the COVID-19 pandemic and mental health outcomes (depression and anxiety) reported up to 1.5 years later. The study was conducted among young (M±SD; 24.08±3.75) men (N = 1025) in Poland. Data were collected by means of self-report questionnaires, including The Social Isolation Index, The Athens Insomnia Scale, The State-Trait Anxiety Inventory (STAI-S) and Beck's Depression Inventory (BDI-II). The results show that insomnia mediates the relationships between social isolation and both anxiety and depression. The current findings emphasize the role of insomnia in the relationships between social isolation experienced during COVID-19 and negative emotional states. From a clinical perspective, the results suggest that implementing therapeutic components that address social isolation in insomnia treatment programs may prevent the development of depression and anxiety symptoms among young men.
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Affiliation(s)
- Justyna Mojsa-Kaja
- Department of Neurobiology and Neuropsychology, Institute of Applied Psychology, Jagiellonian University, Krakow, Poland
| | - Klaudia Szklarczyk-Smolana
- Department of Neurobiology and Neuropsychology, Institute of Applied Psychology, Jagiellonian University, Krakow, Poland
| | - Ewa Niedzielska-Andres
- Chair and Department of Toxicology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Kurpińska
- Jagiellonian Centre for Experimental Therapeutics, Jagiellonian University, Krakow, Poland
| | | | - Maria Walczak
- Chair and Department of Toxicology, Jagiellonian University Medical College, Krakow, Poland
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22
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Felder JN, Roubinov D, Zhang L, Gray M, Beck A. Endorsement of a single-item measure of sleep disturbance during pregnancy and risk for postpartum depression: a retrospective cohort study. Arch Womens Ment Health 2023; 26:67-74. [PMID: 36633715 PMCID: PMC9908713 DOI: 10.1007/s00737-022-01287-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023]
Abstract
Poor prenatal sleep quality is associated with increased risk for depressive symptoms but may go undetected in brief, busy prenatal care visits. Among non-depressed pregnant participants, we evaluated whether 1) the endorsement of sleep disturbance on a depression questionnaire predicted postpartum depressive symptoms, 2) the strength of these associations was higher than other somatic symptoms of pregnancy and depression (i.e., fatigue, appetite disturbance), and 3) the endorsement of prenatal sleep disturbance varied by participant characteristics. In this retrospective cohort study, participants had a live birth and completed Patient Health Questionnaire (PHQ-9) during pregnancy and within 8 weeks postpartum between 2012 and 2017. Participants who were non-depressed during pregnancy (PHQ-9 < 10) were included (n = 3619). We operationalized sleep disturbance, fatigue, and appetite disturbance as endorsement of item 3, 4, and 5 on the PHQ-9, respectively, and postpartum depressive symptoms as PHQ-9 total score ≥ 10. Participant characteristic variables included age, race, ethnicity, parity, gestational age at delivery, and preterm birth. Prenatal sleep disturbance was associated with higher odds of postpartum depressive symptoms (aORs 1.9, 95% CI 1.2-3.1 for first trimester; 3.7, 95% CI 1.5-11.5 for second trimester; 3.4, 95% CI 1.9-6.8 for third trimester). Fatigue and appetite disturbance in the first and third trimesters were associated with higher odds of postpartum depressive symptoms. Sleep disturbance varied by race during the first and second trimesters (p < 0.05) and was highest among Black or African American participants (61.8-65.1%). A routinely administered single-item measure of sleep disturbance could identify otherwise lower-risk pregnant individuals who may benefit from depression prevention efforts.
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Affiliation(s)
- Jennifer N. Felder
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA USA ,Osher Center for Integrative Health, University of California, San Francisco, CA USA
| | - Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA USA
| | - Li Zhang
- Department of Medicine, University of California, San Francisco, CA USA ,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
| | - Mark Gray
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO USA
| | - Arne Beck
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO USA
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23
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Renganathan L, Ramasubramaniam S, Arulappan J, Al Balushi SM, Al Ghassani A, Vijayalakshmi G, Al Balushi A, Dhanraj F. Efficacy of Virtual Cognitive Behavioral Therapy on COVID-19 Pandemic Related Anxiety in a Middle Eastern Country: An Interventional Study. SAGE Open Nurs 2023; 9:23779608231162060. [PMID: 36908329 PMCID: PMC9996730 DOI: 10.1177/23779608231162060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 03/11/2023] Open
Abstract
Introduction Emotional stress and anxiety during COVID-19 pandemic has gained a lot of attention. The capacity to withstand from the manipulated thinking and COVID-19 related stress and anxiety depends on the resilience level of an individual. Cognitive behavioral therapy (CBT) has patronizing benefits for people affected with altered mental health. Relieving COVID-19 related anxiety using CBT has beneficial impact on health and improves quality of life of people. Objective Aimed to relieve the anxiety of Omani population during COVID-19 pandemic using CBT. Methods This research utilized a pre-experimental one group pre-test post-test design. A non-probability convenient sampling technique was used to select 96 Omani people who fulfilled the inclusion criteria. The pre-anxiety level was assessed using CAS (Corona virus Anxiety Scale). The participants who scored above nine in the scale were given three sessions of CBT. Post-anxiety level was assessed using CAS after three CBT sessions. Results The study revealed that the level of anxiety reduced during post-test (6.35) after intervention when compared to pre-test (13.22). The CBT intervention was effective in reducing the anxiety in the post-test at p ≤ .000. Conclusion CBT is effective in reducing COVID-19 related anxiety among the Omani population. Therefore, this strategy is highly recommended in people having mental health issues.
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Affiliation(s)
- Lakshmi Renganathan
- Maternal and Child Health Nursing Department, Oman College of Health Sciences, Ministry of Health, Muscat, Oman
| | - Shanthi Ramasubramaniam
- Adult Health Nursing Department, School of Health and Social Sciences, The University of West of England, Bristol, UK
| | - Judie Arulappan
- Department of Maternal and Child Health, College of Nursing, Sultan Qaboos University, Al Khoudh, Muscat, Oman
| | - Siham Mahmood Al Balushi
- Community Mental Health Nursing Department, Oman College of Health Sciences, Ministry of Health, Muscat, Oman
| | - Amal Al Ghassani
- Community Mental Health Nursing Department, Oman College of Health Sciences, Ministry of Health, Muscat, Oman
| | - G Vijayalakshmi
- Sardar Lal Singh Memorial Institute of Nursing, Desh Bhagat University, Punjab, India
| | - Amal Al Balushi
- Maternal and Child Health Nursing Department, Oman College of Health Sciences, Ministry of Health, Muscat, Oman
| | - Fabiola Dhanraj
- Arulmigu Meenakshi College of Nursing, Kancheepuram (Deemed University), Enathur, Tamil Nadu, India
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24
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Abstract
PURPOSE OF REVIEW There is increasing interest in the connection between sleep disturbances and mood disorders. The purpose of this review is to summarize and evaluate current research on the role of sleep disturbance in the development of depression, as well as to describe recent advances in treatments that improve both sleep and depression symptoms. RECENT FINDINGS Relevant publications included in this review cover a wide range of topics related to sleep and depression. Data from large longitudinal studies suggest that insomnia and evening circadian preference are unique risk factors for depression. Depression treatment studies indicate poorer outcomes for those with comorbid sleep disturbances. A few recent trials of cognitive behavioral therapy for insomnia and triple chronotherapy in unipolar depression have shown promising results. SUMMARY Sleep disturbance is a modifiable risk factor in the development and maintenance of depression. In the context of current depression, although the data is mixed, some evidence suggests treating sleep disturbance can improve overall outcomes. Recent evidence also suggests that treating sleep disturbance may prevent the future depressive episodes.
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25
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Kalmbach DA, Cheng P, Ahmedani BK, Peterson EL, Reffi AN, Sagong C, Seymour GM, Ruprich MK, Drake CL. Cognitive-behavioral therapy for insomnia prevents and alleviates suicidal ideation: insomnia remission is a suicidolytic mechanism. Sleep 2022; 45:zsac251. [PMID: 36242607 PMCID: PMC9742891 DOI: 10.1093/sleep/zsac251] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/21/2022] [Indexed: 11/11/2022] Open
Abstract
STUDY OBJECTIVES Insomnia is associated with elevated levels of suicidal thoughts and behaviors. Emerging evidence suggests that cognitive-behavioral therapy for insomnia (CBTI) may reduce suicidal ideation (SI). However, the role of digital therapeutics in both the alleviation and prevention of SI remains unclear, and treatment mechanisms facilitating SI reductions have not been clearly identified. METHODS A total of 658 adults with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition insomnia disorder enrolled in a single-site randomized controlled trial evaluating the efficacy of digital CBTI relative to attention control. Outcomes were measured at pretreatment, posttreatment, and 1-year follow-up. RESULTS Before treatment, 126 patients endorsed SI (19.1% prevalence). Among those with baseline SI, CBTI patients reported lower SI rates at posttreatment (30.0% vs 54.5%, p = .005) and 1-year follow-up (29.6% vs 46.8%, p = .042) relative to control. PRODCLIN analysis estimated that half of suicidolytic effects of CBTI were mediated through insomnia remission. Among those without baseline SI, CBTI did not directly prevent new onset SI. However, insomnia remitters reported lower rates of new-onset SI at posttreatment relative to non-remitters (1.5% vs 6.5%, p = .009). Mediation analysis supported a significant indirect effect wherein CBTI increased the likelihood of insomnia remission, which was associated with SI prevention (αβ = -3.20, 95% CI = -5.74 to -0.87). CONCLUSION Digital CBTI reduces insomnia symptoms, which promotes SI alleviation and prevention. For nonsuicidal patients, digital CBTI may serve as a highly accessible monotherapy for improving sleep, thereby reducing the risk for SI. For suicidal patients, digital CBTI may be appropriately administered as an adjunct treatment to support mainline intervention more directly targeting suicidogenic thoughts.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Edward L Peterson
- Department of Public Health Services, Henry Ford Health System, Detroit, MI, USA
- Department of Epidemiology, Henry Ford Health System, Detroit, MI, USA
| | - Anthony N Reffi
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Chaewon Sagong
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Grace M Seymour
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Melissa K Ruprich
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
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26
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Sleep to Reduce Incident Depression Effectively (STRIDE): study protocol for a randomized controlled trial comparing stepped-care cognitive-behavioral therapy for insomnia versus sleep education control to prevent major depression. Trials 2022; 23:967. [PMID: 36457045 PMCID: PMC9713737 DOI: 10.1186/s13063-022-06850-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/19/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Prevention of major depressive disorder (MDD) is a public health priority. Strategies targeting individuals at elevated risk for MDD may guide effective preventive care. Insomnia is a reliable precursor to depression, preceding half of all incident and relapse cases. Thus, insomnia may serve as a useful entry point for preventing MDD. Cognitive-behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment for insomnia, but widespread implementation is limited by a shortage of trained specialists. Innovative stepped-care approaches rooted in primary care can increase access to CBT-I and reduce rates of MDD. METHODS/DESIGN We propose a large-scale stepped-care clinical trial in the primary care setting that utilizes a sequential, multiple assignment, randomized trial (SMART) design to determine the effectiveness of dCBT-I alone and in combination with clinician-led CBT-I for insomnia and the prevention of MDD incidence and relapse. Specifically, our care model uses digital CBT-I (dCBT-I) as a first-line intervention to increase care access and reduce the need for specialist resources. Our proposal also adds clinician-led CBT-I for patients who do not remit with first-line intervention and need a more personalized approach from specialty care. We will evaluate negative repetitive thinking as a potential treatment mechanism by which dCBT-I and CBT-I benefit insomnia and depression outcomes. DISCUSSION This project will test a highly scalable model of sleep care in a large primary care system to determine the potential for wide dissemination and implementation to address the high volume of population need for safe and effective insomnia treatment and associated prevention of depression. TRIAL REGISTRATION ClinicalTrials.gov NCT03322774. Registered on October 26, 2017.
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27
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Comorbid Insomnia and Sleep Apnea. Sleep Med Clin 2022; 17:597-617. [DOI: 10.1016/j.jsmc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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28
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Reid MJ, Huhn AS, Finan PH. Pharmacological interventions for insomnia disorder in adults. Lancet 2022; 400:1845-1846. [PMID: 36436525 DOI: 10.1016/s0140-6736(22)02031-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/10/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Matthew J Reid
- Department of Psychiatry & Behavioral Sciences, Medical School, Johns Hopkins University, Baltimore, MD 21224, USA.
| | - Andrew S Huhn
- Department of Psychiatry & Behavioral Sciences, Medical School, Johns Hopkins University, Baltimore, MD 21224, USA
| | - Patrick H Finan
- Department of Psychiatry & Behavioral Sciences, Medical School, Johns Hopkins University, Baltimore, MD 21224, USA; Department of Anesthesiology, School of Medicine, University of Virginia, Charlottesville, VA, USA
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29
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The platform development, adherence and efficacy to a digital Brief therapy for insomnia (dBTI) during the COVID-19 pandemic. Methods 2022; 205:39-45. [PMID: 35526723 PMCID: PMC9070004 DOI: 10.1016/j.ymeth.2022.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/10/2022] [Accepted: 04/29/2022] [Indexed: 01/04/2023] Open
Abstract
Brief therapy for insomnia (BTI) is a short-term cognitive behavioral therapy for insomnia. At present, there is no study combining BTI with digital technology. However, in the context of the outbreak of coronavirus disease 2019 (COVID-19), patients with acute insomnia may need an online treatment which can quickly improve insomnia symptoms. Our team built a digital BTI (dBTI) platform based on the WeChat mini program. This research provides a framework design and a course design of dBTI, and evaluates the system via recruiting participants suffering from acute insomnia in pandemic. What's more, it explores patients' adherence, the efficiency of the system and their relationship. As the result demonstrates, 68% of participants have completed more than half of the course with medium to high adherence. Gender, pre-sleep arousal scale (PSAS) somatic score and insomnia severity index (ISI) score have affected participants' adherence, and higher adherence has led to better improvement in the severity of insomnia and somatic pre-sleep arousal. It is proved that the platform we built is effective, which not only offers an entry point for the study of how to set up a dBTI platform, but also provides theoretical basis for its clinical application.
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30
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Reffi AN, Drake CL, Kalmbach DA, Jovanovic T, Norrholm SD, Roth T, Casement MD, Cheng P. Pre-pandemic sleep reactivity prospectively predicts distress during the COVID-19 pandemic: The protective effect of insomnia treatment. J Sleep Res 2022; 32:e13709. [PMID: 36053867 PMCID: PMC9537903 DOI: 10.1111/jsr.13709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 02/03/2023]
Abstract
The COVID-19 pandemic is a rare stressor that has precipitated an accompanying mental health crisis. Prospective studies traversing the pandemic's onset can elucidate how pre-existing disease vulnerabilities augured risk for later stress-related morbidity. We examined how pre-pandemic sleep reactivity predicted maladaptive stress reactions and depressive symptoms in response to, and during, the pandemic. This study is a secondary analysis of a randomised controlled trial from 2016 to 2017 comparing digital cognitive behavioural therapy for insomnia (dCBT-I) against sleep education (N = 208). Thus, we also assessed whether dCBT-I moderated the association between pre-pandemic sleep reactivity and pandemic-related distress. Pre-pandemic sleep reactivity was measured at baseline using the Ford Insomnia Response to Stress Test. In April 2020, participants were recontacted to report pandemic-related distress (stress reactions and depression). Controlling for the treatment condition and the degree of COVID-19 impact, higher pre-pandemic sleep reactivity predicted more stress reactions (β = 0.13, ± 0.07 SE, p = 0.045) and depression (β = 0.22, ± 0.07 SE, p = 0.001) during the pandemic. Further, the odds of reporting clinically significant stress reactions and depression during the pandemic were over twice as high in those with high pre-pandemic sleep reactivity. Notably, receiving dCBT-I in 2016-2017 mitigated the relationship between pre-pandemic sleep reactivity and later stress reactions (but not depression). Pre-pandemic sleep reactivity predicted psychological distress 3-4 years later during the COVID-19 pandemic, and dCBT-I attenuated its association with stress reactions, specifically. Sleep reactivity may inform prevention and treatment efforts by identifying individuals at risk of impairment following stressful events.
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Affiliation(s)
- Anthony N. Reffi
- Sleep Disorders & Research CenterHenry Ford Health SystemDetroitMichiganUSA
| | | | - David A. Kalmbach
- Sleep Disorders & Research CenterHenry Ford Health SystemDetroitMichiganUSA
| | - Tanja Jovanovic
- Neuroscience Center for Anxiety, Stress, and Trauma (NeuroCAST), Department of Psychiatry and Behavioral NeurosciencesWayne State University School of MedicineDetroitMichiganUSA
| | - Seth D. Norrholm
- Neuroscience Center for Anxiety, Stress, and Trauma (NeuroCAST), Department of Psychiatry and Behavioral NeurosciencesWayne State University School of MedicineDetroitMichiganUSA
| | - Thomas Roth
- Sleep Disorders & Research CenterHenry Ford Health SystemDetroitMichiganUSA
| | | | - Philip Cheng
- Sleep Disorders & Research CenterHenry Ford Health SystemDetroitMichiganUSA
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Spiegelhalder K, Crönlein T. Aktuelle Entwicklungen in der Schlafforschung und Schlafmedizin – eine Einschätzung der AG „Insomnie“. SOMNOLOGIE 2022. [DOI: 10.1007/s11818-022-00370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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32
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Li ZR, Liu DG, Xie S, Wang YH, Han YS, Li CY, Zou MS, Jiang HX. Sleep deprivation leads to further impairment of hippocampal synaptic plasticity by suppressing melatonin secretion in the pineal gland of chronically unpredictable stress rats. Eur J Pharmacol 2022; 930:175149. [PMID: 35878808 DOI: 10.1016/j.ejphar.2022.175149] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/23/2022] [Accepted: 07/07/2022] [Indexed: 11/27/2022]
Abstract
There has been ample research showing that insomnia is a potential trigger of depression as well as a symptom of depression. These two factors contribute to behavioral problems and are closely related to the plasticity of hippocampal synapses. Although depression and insomnia impair hippocampal synaptic plasticity, the mechanism by which this happens remains a mystery. This study aimed to investigate the pathogenesis of insomnia comorbidity in depression and the regulatory effect of venlafaxine combined with melatonin on hippocampal synaptic plasticity in chronic unpredictable mild stress (CUMS) with sleep deprivation (SD) rats. Thus, rats were subjected to 14 days of chronic mild unpredictable stress, gradually acclimated to sleep deprivation on days 12-14. Followed by 21 consecutive days of sleep deprivation, 18 hours per day, with daily gavage of venlafaxine (13.5 mg/kg) + melatonin (72 mg/kg) on days 15-36. Venlafaxine + melatonin treatment improves depression-like behavior, pentobarbital sodium experimental sleep latency, and sleep duration in CUMS +SD rats. In addition to improving depressive-like behaviors, sleep deprivation also upregulates the expression of caspase-specific cysteine protein 3 (Caspase 3) in the pineal glial cells of chronic mild rats, as well as in hippocampal microglia. Expression of ionic calcium-binding adaptor 1 (iba-1), downregulates the secretion of several synaptic plasticity-related proteins, notably cAMP response element binding protein (CREB), glial cell line-derived neurotrophic factor (GDNF), and the synaptic scaffolding protein Spinophiline (Spinophiline). Hematoxylin-eosin staining showed that the structure of the pineal gland and hippocampus was damaged, and Golgi staining showed that the dendrites and spines in the DG area of the hippocampus were destroyed, vaguely aggregated or even disappeared, and the connection network could not be established. Western blot analysis further revealed a positive correlation between low melatonin levels and reduced Spinophiline protein. Interestingly, venlafaxine + melatonin reversed these events by promoting hippocampal synaptic plasticity by regulating melatonin secretion from the pineal gland. Therefore, it exerted an antidepressant effect in sleep deprivation combined with CUMS model rats. Overall, the results of this study suggest that the pathophysiology of depressive insomnia comorbidity is mediated by impaired pineal melatonin secretion and impaired hippocampal synaptic plasticity. In addition, these responses are associated with melatonin secretion from the pineal gland.
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Affiliation(s)
- Zi-Rong Li
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi, Nanning, 530022, China; State Key Laboratory of Chinese Medicine Powder and Medicine Innovation in Hunan (incubation), Hunan University of Chinese Medicine, Hunan, Changsha, 410208, China
| | - De-Guo Liu
- Department of Breast Surgery, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi, Nanning, 530022, China
| | - Sheng Xie
- Prevention of Diseases with Traditional Chinese Medicine Center, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi, Nanning, 530022, China.
| | - Yu-Hong Wang
- State Key Laboratory of Chinese Medicine Powder and Medicine Innovation in Hunan (incubation), Hunan University of Chinese Medicine, Hunan, Changsha, 410208, China.
| | - Yuan-Shan Han
- Department of Experimental Center for Medical Innovation, The First Affiliated Hospital of Hunan University of Chinese Medicine, Hunan, Changsha, 410021, China
| | - Chun-Yan Li
- State Key Laboratory of Chinese Medicine Powder and Medicine Innovation in Hunan (incubation), Hunan University of Chinese Medicine, Hunan, Changsha, 410208, China
| | - Man-Shu Zou
- State Key Laboratory of Chinese Medicine Powder and Medicine Innovation in Hunan (incubation), Hunan University of Chinese Medicine, Hunan, Changsha, 410208, China
| | - Hai-Xing Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Guangxi, Nanning, 530021, China
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Digital tools for the assessment of pharmacological treatment for depressive disorder: State of the art. Eur Neuropsychopharmacol 2022; 60:100-116. [PMID: 35671641 DOI: 10.1016/j.euroneuro.2022.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 12/23/2022]
Abstract
Depression is an invalidating disorder, marked by phenotypic heterogeneity. Clinical assessments for treatment adjustments and data-collection for pharmacological research often rely on subjective representations of functioning. Better phenotyping through digital applications may add unseen information and facilitate disentangling the clinical characteristics and impact of depression and its pharmacological treatment in everyday life. Researchers, physicians, and patients benefit from well-understood digital phenotyping approaches to assess the treatment efficacy and side-effects. This review discusses the current possibilities and pitfalls of wearables and technology for the assessment of the pharmacological treatment of depression. Their applications in the whole spectrum of treatment for depression, including diagnosis, treatment of an episode, and monitoring of relapse risk and prevention are discussed. Multiple aspects are to be considered, including concerns that come with collecting sensitive data and health recordings. Also, privacy and trust are addressed. Available applications range from questionnaire-like apps to objective assessment of behavioural patterns and promises in handling suicidality. Nonetheless, interpretation and integration of this high-resolution information with other phenotyping levels, remains challenging. This review provides a state-of-the-art description of wearables and technology in digital phenotyping for monitoring pharmacological treatment in depression, focusing on the challenges and opportunities of its application in clinical trials and research.
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Raman S, Hyland P, Coogan AN. Temporal associations between insomnia and depression symptoms in adults during the COVID-19 pandemic: A cross-lagged path modelling analysis. Psychiatry Res 2022; 312:114533. [PMID: 35381505 PMCID: PMC8964445 DOI: 10.1016/j.psychres.2022.114533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/07/2022] [Accepted: 03/26/2022] [Indexed: 11/24/2022]
Abstract
It is well recognised that there is an intimate relationship between sleep and depression, with poor quality or short duration sleep associated with greater symptoms of depression. However, it is not clear from the current evidence base what the temporal relationship is between symptoms of insomnia and depression. Further, it is also unclear how the COVID-19 pandemic may impact on such relationships. In this study we have examined the longitudinal relationships between symptoms of depression and insomnia during the COVID-19 pandemic at two points separated by one year (April/May 2020 and March/April 2021) in a sample of 1032 Irish adults using a cross-lagged paths model. We report that there is a bidirectional relationship across time between depression and insomnia symptoms (β = -0.115 between Insomnia symptoms and subsequent depression symptoms and β = -0.163 between depression symptoms and subsequent insomnia symptoms; scales scored in opposite directions), and that these relationships persist when COVID-19 anxiety, age and sex are introduced into the model. Our analyses suggest that during the first year of the COVID-19 pandemic that insomnia symptoms predicted depression symptoms one year later, and conversely that depression symptoms predicted subsequent insomnia symptoms.
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35
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Hurtte E, Rogers BD, Richards C, Gyawali CP. The clinical value of psycho-gastroenterological interventions for functional esophageal symptoms. Neurogastroenterol Motil 2022; 34:e14315. [PMID: 34994058 DOI: 10.1111/nmo.14315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/09/2021] [Accepted: 12/21/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND Disorders of gut-brain interaction (DGBI) are associated with high symptom burden and poor quality of life. We evaluated the clinical value of multimodal therapy with psycho-gastroenterological interventions in patients with refractory functional symptoms. METHODS Of 80 DGBI patients managed over a 12-month period, 26 patients undergoing multimodal therapy (median age 60.0 years, 73.1%F) were compared to 54 patients (median age 56.0 years, 68.5%F) managed using conventional approaches. Psycho-gastroenterological multimodal therapy was individualized and included relaxation training (diaphragmatic breathing, passive muscle relaxation) and gut-direct hypnotherapy/guided imagery. All patients completed documentation of symptom frequency and severity using a 100 mm visual analog scale (VAS) and assessment of health-related quality of life (BEST score) before and following therapy. Data were analyzed to determine comparative change in symptom burden between the two cohorts. KEY RESULTS Baseline demographics and symptom burden were similar between the two treatment subgroups. While patients improved with both multimodal and conventional therapies, BEST score demonstrated greater improvement with multimodal therapy (p = 0.03). Physician perception of symptom burden at baseline and on follow-up did not correspond to self-reported questionnaire data. On multivariable analysis, multimodal therapy (OR 7.9, 95% CI 1.8-34.6, p = 0.006) and functional esophageal disorders (OR 17.6, 95% CI 2.6-121.1, p = 0.004) predicted >50% improvement in BEST score, while the presence of psychiatric disease was a negative predictor (OR 0.22, CI 0.05-0.94, p = 0.04). CONCLUSIONS & INFERENCES Psychological intervention using multimodal therapy provides clinical value to the management of functional esophageal symptoms among patients refractory to conventional therapy.
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Affiliation(s)
- Edward Hurtte
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Benjamin D Rogers
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.,Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Cheryl Richards
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
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Leerssen J, Lakbila-Kamal O, Dekkers LMS, Ikelaar SLC, Albers ACW, Blanken TF, Lancee J, van der Lande GJM, Maksimovic T, Mastenbroek SE, Reesen JE, van de Ven S, van der Zweerde T, Foster-Dingley JC, Van Someren EJW. Treating Insomnia with High Risk of Depression Using Therapist-Guided Digital Cognitive, Behavioral, and Circadian Rhythm Support Interventions to Prevent Worsening of Depressive Symptoms: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:168-179. [PMID: 34872087 DOI: 10.1159/000520282] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The global disease burden of major depressive disorder urgently requires prevention in high-risk individuals, such as recently discovered insomnia subtypes. Previous studies targeting insomnia with fully automated eHealth interventions to prevent depression are inconclusive: dropout was high and likely biased, and depressive symptoms in untreated participants on average improved rather than worsened. OBJECTIVE This randomized controlled trial aimed to efficiently prevent the worsening of depressive symptoms by selecting insomnia subtypes at high risk of depression for internet-based circadian rhythm support (CRS), cognitive behavioral therapy for insomnia (CBT-I), or their combination (CBT-I+CRS), with online therapist guidance to promote adherence. METHODS Participants with an insomnia disorder subtype conveying an increased risk of depression (n = 132) were randomized to no treatment (NT), CRS, CBT-I, or CBT-I+CRS. The Inventory of Depressive Symptomatology - Self Report (IDS-SR) was self-administered at baseline and at four follow-ups spanning 1 year. RESULTS Without treatment, depressive symptoms indeed worsened (d = 0.28, p = 0.041) in high-risk insomnia, but not in a reference group with low-risk insomnia. Therapist-guided CBT-I and CBT-I+CRS reduced IDS-SR ratings across all follow-up assessments (respectively, d = -0.80, p = 0.001; d = -0.95, p < 0.001). Only CBT-I+CRS reduced the 1-year incidence of clinically meaningful worsening (p = 0.002). Dropout during therapist-guided interventions was very low (8%) compared to previous automated interventions (57-62%). CONCLUSIONS The findings tentatively suggest that the efficiency of population-wide preventive strategies could benefit from the possibility to select insomnia subtypes at high risk of developing depression for therapist-guided digital CBT-I+CRS. This treatment may provide effective long-term prevention of worsening of depressive symptoms. TRIAL REGISTRATION the Netherlands Trial Register (NL7359).
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Affiliation(s)
- Jeanne Leerssen
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Oti Lakbila-Kamal
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Laura M S Dekkers
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Savannah L C Ikelaar
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Anne C W Albers
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Tessa F Blanken
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.,PsyQ Amsterdam, Amsterdam, The Netherlands
| | - Glenn J M van der Lande
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Teodora Maksimovic
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Sophie E Mastenbroek
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Joyce E Reesen
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Sjors van de Ven
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Tanja van der Zweerde
- Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands.,Specialized Mental Health Care GGZ inGeest, Amsterdam, The Netherlands
| | - Jessica C Foster-Dingley
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
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Otto MW, Birk JL, Fitzgerald HE, Chauvin GV, Gold AK, Carl JR. Stage models for major depression: Cognitive behavior therapy, mechanistic treatment targets, and the prevention of stage transition. Clin Psychol Rev 2022; 95:102172. [DOI: 10.1016/j.cpr.2022.102172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/12/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
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Riemann D, Benz F, Dressle RJ, Espie CA, Johann AF, Blanken TF, Leerssen J, Wassing R, Henry AL, Kyle SD, Spiegelhalder K, Van Someren EJW. Insomnia disorder: State of the science and challenges for the future. J Sleep Res 2022; 31:e13604. [PMID: 35460140 DOI: 10.1111/jsr.13604] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 12/25/2022]
Abstract
Insomnia disorder comprises symptoms during night and day that strongly affect quality of life and wellbeing. Prolonged sleep latency, difficulties to maintain sleep and early morning wakening characterize sleep complaints, whereas fatigue, reduced attention, impaired cognitive functioning, irritability, anxiety and low mood are key daytime impairments. Insomnia disorder is well acknowledged in all relevant diagnostic systems: Diagnostic and Statistical Manual of the American Psychiatric Association, 5th revision, International Classification of Sleep Disorders, 3rd version, and International Classification of Diseases, 11th revision. Insomnia disorder as a chronic condition is frequent (up to 10% of the adult population, with a preponderance of females), and signifies an important and independent risk factor for physical and, especially, mental health. Insomnia disorder diagnosis primarily rests on self-report. Objective measures like actigraphy or polysomnography are not (yet) part of the routine diagnostic canon, but play an important role in research. Disease concepts of insomnia range from cognitive-behavioural models to (epi-) genetics and psychoneurobiological approaches. The latter is derived from knowledge about basic sleep-wake regulation and encompass theories like rapid eye movement sleep instability/restless rapid eye movement sleep. Cognitive-behavioural models of insomnia led to the conceptualization of cognitive-behavioural therapy for insomnia, which is now considered as first-line treatment for insomnia worldwide. Future research strategies will include the combination of experimental paradigms with neuroimaging and may benefit from more attention to dysfunctional overnight alleviation of distress in insomnia. With respect to therapy, cognitive-behavioural therapy for insomnia merits widespread implementation, and digital cognitive-behavioural therapy may assist delivery along treatment guidelines. However, given the still considerable proportion of patients responding insufficiently to cognitive-behavioural therapy for insomnia, fundamental studies are highly necessary to better understand the brain and behavioural mechanisms underlying insomnia. Mediators and moderators of treatment response/non-response and the associated development of tailored and novel interventions also require investigation. Recent studies suggest that treatment of insomnia may prove to add significantly as a preventive strategy to combat the global burden of mental disorders.
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Affiliation(s)
- Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fee Benz
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Raphael J Dressle
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Colin A Espie
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Ltd, London, UK.,Big Health Ltd, San Francisco, California, USA
| | - Anna F Johann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tessa F Blanken
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeanne Leerssen
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Rick Wassing
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alasdair L Henry
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Ltd, London, UK.,Big Health Ltd, San Francisco, California, USA
| | - Simon D Kyle
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
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Liu X, Huang S, Hu Y, Wang G. The effectiveness of telemedicine interventions on women with postpartum depression: A systematic review and meta-analysis. Worldviews Evid Based Nurs 2022; 19:175-190. [PMID: 35349219 DOI: 10.1111/wvn.12576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/23/2021] [Accepted: 12/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postpartum depression (PPD) is a public health problem that has significant adverse effects on mothers, couple's relationships, newborn neurodevelopment, and child emotional and cognitive development. This study reviewed the effectiveness of telemedicine interventions in postparturient women with postpartum depression. AIMS To evaluate the effectiveness of telemedicine intervention in women with postpartum depression. METHODS Cochrane Library, PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO were searched for relevant articles published between 2003 and March 2021. We also manually reviewed the reference lists of the retrieved articles. The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias for individual studies was evaluated according to the Cochrane Handbook. RevMan 5.4 software was used to carry out the meta-analysis. RESULTS The meta-analysis included 20 randomized controlled trials with a total of 3252 patients. The results demonstrated that telemedicine was an effective intervention for treating PPD and anxiety and for improving functional impairment in women during their postpartum period. LINKING EVIDENCE TO ACTION This meta-analysis provided evidence that telemedicine was an effective intervention for treating PPD in women. Telemedicine also has significant effects on anxiety and improved functional impairment in women during their postpartum period. Our findings may provide accurate evidence-based guidance for postpartum women's mental health management. In the future, more high-quality studies are required for verifying these results.
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Affiliation(s)
- Xueyan Liu
- School of Nursing, Shandong University, Jinan City, China
| | - Sasa Huang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Ying Hu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Guangpeng Wang
- Xiangya School of Nursing, Central South University, Changsha, China
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40
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Denecke K, Schmid N, Nüssli S. Implementation of Cognitive Behavioral Therapy in e-Mental Health Apps: Literature Review. J Med Internet Res 2022; 24:e27791. [PMID: 35266875 PMCID: PMC8949700 DOI: 10.2196/27791] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/27/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022] Open
Abstract
Background To address the matter of limited resources for treating individuals with mental disorders, e–mental health has gained interest in recent years. More specifically, mobile health (mHealth) apps have been suggested as electronic mental health interventions accompanied by cognitive behavioral therapy (CBT). Objective This study aims to identify the therapeutic aspects of CBT that have been implemented in existing mHealth apps and the technologies used. From these, we aim to derive research gaps that should be addressed in the future. Methods Three databases were screened for studies on mHealth apps in the context of mental disorders that implement techniques of CBT: PubMed, IEEE Xplore, and ACM Digital Library. The studies were independently selected by 2 reviewers, who then extracted data from the included studies. Data on CBT techniques and their technical implementation in mHealth apps were synthesized narratively. Results Of the 530 retrieved citations, 34 (6.4%) studies were included in this review. mHealth apps for CBT exploit two groups of technologies: technologies that implement CBT techniques for cognitive restructuring, behavioral activation, and problem solving (exposure is not yet realized in mHealth apps) and technologies that aim to increase user experience, adherence, and engagement. The synergy of these technologies enables patients to self-manage and self-monitor their mental state and access relevant information on their mental illness, which helps them cope with mental health problems and allows self-treatment. Conclusions There are CBT techniques that can be implemented in mHealth apps. Additional research is needed on the efficacy of the mHealth interventions and their side effects, including inequalities because of the digital divide, addictive internet behavior, lack of trust in mHealth, anonymity issues, risks and biases for user groups and social contexts, and ethical implications. Further research is also required to integrate and test psychological theories to improve the impact of mHealth and adherence to the e–mental health interventions.
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Affiliation(s)
- Kerstin Denecke
- Institute for Medical Informatics, Bern University of Applied Sciences, Biel, Switzerland
| | | | - Stephan Nüssli
- Institute for Medical Informatics, Bern University of Applied Sciences, Biel, Switzerland
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Circadian and Sleep Modulation of Dreaming in Women with Major Depression. Clocks Sleep 2022; 4:114-128. [PMID: 35323166 PMCID: PMC8947272 DOI: 10.3390/clockssleep4010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022] Open
Abstract
Growing evidence indicates an association between reduced dream recall and depressive symptomatology. Here, we tested the prediction that reduced dream recall in individuals experiencing major depressive disorder (MDD) is due to alterations in circadian and sleep processes. Nine young healthy women (20−31 years) and eight young unmedicated women (20−31 years) diagnosed with MDD underwent a 40 h multiple nap protocol with ten alternating cycles of 150 min wake/75 min sleep under a stringently controlled circadian laboratory protocol. After each nap, we assessed dream recall, number of dreams and dream emotional load using the Sleep Mentation Questionnaire. Dream recall and the number of dreams did not significantly differ between groups (pFDR > 0.1). However, there was a significant difference for the dream emotional load (interaction of “Group” vs. “Time”, pFDR = 0.01). Women with MDD had a two-fold higher (negative) emotional load as compared to healthy control women, particularly after naps during the circadian night (between ~22:00 h and ~05:00 h; Tukey−Kramer test, p = 0.009). Furthermore, higher (negative) dream emotional load was associated with impaired mood levels in both groups (R2 = 0.71; p < 0.001). Our findings suggest that the circadian and sleep modulation of dreaming may remain intact in unmedicated young women experiencing MDD.
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Yoon H, Baek HJ. External Auditory Stimulation as a Non-Pharmacological Sleep Aid. SENSORS (BASEL, SWITZERLAND) 2022; 22:1264. [PMID: 35162009 PMCID: PMC8838436 DOI: 10.3390/s22031264] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/09/2021] [Accepted: 01/27/2022] [Indexed: 02/07/2023]
Abstract
The increased demand for well-being has fueled interest in sleep. Research in technology for monitoring sleep ranges from sleep efficiency and sleep stage analysis to sleep disorder detection, centering on wearable devices such as fitness bands, and some techniques have been commercialized and are available to consumers. Recently, as interest in digital therapeutics has increased, the field of sleep engineering demands a technology that helps people obtain quality sleep that goes beyond the level of monitoring. In particular, interest in sleep aids for people with or without insomnia but who cannot fall asleep easily at night is increasing. In this review, we discuss experiments that have tested the sleep-inducing effects of various auditory stimuli currently used for sleep-inducing purposes. The auditory stimulations were divided into (1) colored noises such as white noise and pink noise, (2) autonomous sensory meridian response sounds such as natural sounds such as rain and firewood burning, sounds of whispers, or rubbing various objects with a brush, and (3) classical music or a preferred type of music. For now, the current clinical method of receiving drugs or cognitive behavioral therapy to induce sleep is expected to dominate. However, it is anticipated that devices or applications with proven ability to induce sleep clinically will begin to appear outside the hospital environment in everyday life.
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Affiliation(s)
- Heenam Yoon
- Department of Human-Centered Artificial Intelligence, Sangmyung University, Seoul 03016, Korea;
| | - Hyun Jae Baek
- Department of Medical and Mechatronics Engineering, Soonchunhyung University, Asan 31538, Korea
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Spanhel K, Hovestadt E, Lehr D, Spiegelhalder K, Baumeister H, Bengel J, Sander LB. Engaging Refugees With a Culturally Adapted Digital Intervention to Improve Sleep: A Randomized Controlled Pilot Trial. Front Psychiatry 2022; 13:832196. [PMID: 35280163 PMCID: PMC8905517 DOI: 10.3389/fpsyt.2022.832196] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/31/2022] [Indexed: 01/09/2023] Open
Abstract
Refugees are exposed to multiple stressors affecting their mental health. Given various barriers to mental healthcare in the arrival countries, innovative healthcare solutions are needed. One such solution could be to offer low-threshold treatments, for example by culturally adapting treatments, providing them in a scalable format, and addressing transdiagnostic symptoms. This pilot trial examined the feasibility, acceptance, and preliminary effectiveness of a culturally adapted digital sleep intervention for refugees. Sixty-six refugees participated, with 68.2% of them seeking psychological help for the first time. Only three participants did not show clinically significant insomnia severity, 93.9% reported past traumatic experiences. Participants were randomly assigned to the intervention group (IG) or the waitlist control group (CG). Insomnia severity, measured by the Insomnia Severity Index, and secondary outcomes (sleep quality, fear of sleep, fatigue, depression, wellbeing, mental health literacy) were assessed at baseline, 1 and 3 months after randomization. The self-help intervention included four modules on sleep hygiene, rumination, and information on mental health conditions associated with sleep disturbances. 66.7% of the IG completed all modules. Satisfaction with the intervention and its perceived cultural appropriateness were high. Linear multilevel analyses revealed a small, non-significant intervention effect on insomnia severity of Hedge's g = 0.28 at 3-months follow-up, comparing the IG to the CG [F 2, 60 = 0.88, p = 0.421]. This non-confirmatory pilot trial suggests that low-threshold, viable access to mental healthcare can be offered to multiple burdened refugees by culturally adapting an intervention, providing it in a scalable format, and addressing a transdiagnostic symptom.
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Affiliation(s)
- Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Eva Hovestadt
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Dirk Lehr
- Department of Health Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Juergen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
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Jernelöv S, Killgren J, Ledin L, Kaldo V. Treatment feasibility and preliminary evaluation of group-delivered cognitive behavioral therapy for insomnia adapted for patients with bipolar and related disorders: A pragmatic within-group study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2021.100293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Irwin MR, Carrillo C, Sadeghi N, Bjurstrom MF, Breen EC, Olmstead R. Prevention of Incident and Recurrent Major Depression in Older Adults With Insomnia: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:33-41. [PMID: 34817561 PMCID: PMC8733847 DOI: 10.1001/jamapsychiatry.2021.3422] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
IMPORTANCE Older adults with insomnia have a high risk of incident and recurrent depression. Depression prevention is urgently needed, and such efforts have been neglected for older adults. OBJECTIVE To examine whether treatment of insomnia disorder with cognitive behavioral therapy for insomnia (CBT-I) compared with an active comparator condition, sleep education therapy (SET), prevents major depressive disorder in older adults. DESIGN, SETTING, AND PARTICIPANTS This assessor-blinded, parallel-group, single-site randomized clinical trial assessed a community-based sample of 431 people and enrolled 291 adults 60 years or older with insomnia disorder who had no major depression or major health events in past year. Study recruitment was performed from July 1, 2012, to April 30, 2015. The trial protocol was modified to extend follow-up from 24 to 36 months, with follow-up completion in July 2018. Data analysis was performed from March 1, 2019, to March 30, 2020. INTERVENTIONS Participants were randomized to 2 months of CBT-I (n = 156) or SET (n = 135). MAIN OUTCOMES AND MEASURES The primary outcome was time to incident major depressive disorder as diagnosed by interview and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria. Secondary outcome was sustained remission of insomnia disorder before depression event or duration of follow-up. RESULTS Among 291 randomized participants (mean [SD] age, 70.1 [6.7] years; 168 [57.7%] female; 7 [2.4%] Asian, 32 [11.0%] Black, 3 [1.0%] Pacific Islander, 241 [82.8%] White, 6 [2.1%] multiracial, and 2 [0.7%] unknown), 156 were randomized to CBT-I and 135 to SET. A total of 140 participants (89.7%) completed CBT-I and 130 (96.3%) participants completed SET (χ2 = 4.9, P = .03), with 114 (73.1%) completing 24 months of follow-up in the CBT-I group and 117 (86.7%) in the SET group (χ2 = 8.4, P = .004). After protocol modification, 92 (59.0%) of the CBT-I participants and 86 (63.7%) of the SET participants agreed to extended follow-up (χ2 = 0.7, P = .41), with 81 (51.9%) of the CBT-I participants and 77 (57.0%) of the SET group completing 36 months of follow-up (χ2 = 0.8; P = .39). Incident or recurrent major depression occurred in 19 participants (12.2%) in the CBT-I group and in 35 participants (25.9%) in the SET group, with an overall benefit (hazard ratio, 0.51; 95%, CI 0.29-0.88; P = .02) consistent across subgroups. Remission of insomnia disorder continuously sustained before depression event or during follow-up was more likely in CBT-I participants (41 [26.3%]) compared with the SET participants (26 [19.3%], P = .03). Those in the CBT-I group with sustained remission of insomnia disorder had an 82.6% decreased likelihood of depression (hazard ratio, 0.17; 95%, CI 0.04-0.73; P = .02) compared with those in the SET group without sustained remission of insomnia disorder. CONCLUSIONS AND RELEVANCE The findings of this randomized clinical trial indicate that treatment of insomnia with CBT-I has an overall benefit in the prevention of incident and recurrent major depression in older adults with insomnia disorder. Community-level screening for insomnia concerns in older adults and wide delivery of CBT-I-based treatment for insomnia could substantially advance public health efforts to treat insomnia and prevent depression in this vulnerable older adult population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01641263.
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Affiliation(s)
- Michael R. Irwin
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles),Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA
| | - Carmen Carrillo
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Nina Sadeghi
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Martin F. Bjurstrom
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Elizabeth C. Breen
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles),Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA
| | - Richard Olmstead
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles),Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA
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46
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Diagnosis of Insomnia Disorder. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Donohoe F, O'Meara Y, Roberts A, Comerford L, Kelly CM, Walshe JM, Peate M, Hickey M, Brennan DJ. The menopause after cancer study (MACS) - A multimodal technology assisted intervention for the management of menopausal symptoms after cancer - Trial protocol of a phase II study. Contemp Clin Trials Commun 2021; 24:100865. [PMID: 34869938 PMCID: PMC8626829 DOI: 10.1016/j.conctc.2021.100865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/06/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Aims This study will aim to assess if a composite intervention which involves a specific evidence-based intervention for management of insomnia and non-hormonal pharmacotherapy to manage vasomotor symptoms (VMS) of menopause can improve quality of life for patients experiencing troublesome VMS after cancer who are not eligible for standard systemic menopausal hormone therapy (MHT). Participants will be asked to nominate a partner or companion to support them during this process as an additional form of support. Background The menopause transition and its symptoms represent a significant challenge for many patients after cancer treatment, particularly those for whom conventional MHT is contraindicated. These symptoms include hot flushes, night sweats, urogenital symptoms as well as mood and sleep disturbance. These symptoms can exacerbate the consequences of cancer and its treatment. Methods We will recruit 205 women who meet inclusion criteria and enrol them on a composite intervention which consists of four parts: (1) use of non-hormonal pharmacotherapy for the management of troublesome vasomotor symptoms of menopause tailored to the timing of predominant symptoms, (2) digital cognitive behavioural therapy for insomnia through the web based Sleepio service, (3) access to information regarding self-management strategies for the common symptoms of menopause and their consequences and (4) identification of a partner or other support person who commits to providing support during the study period. Outcomes The primary outcome will be cancer specific quality of life measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C30). Secondary outcomes will include sleep quality, bother/interference of vasomotor symptoms and communication between couples about their cancer diagnosis and their menopause experience. Sleep will be measured using the Sleep Condition Indicator (SCI) tool, bother/interference of vasomotor symptoms will be measured by the Hot Flush Rating Scale (HFRS) and communication will be measured using the Couples’ Illness Communication Scale (CICS). These validated scales will be administered at baseline, four weeks, three months and six months. Registration This study is registered on ClinicalTrials.gov with number NCT 04766229.
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Affiliation(s)
- Fionán Donohoe
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Yvonne O'Meara
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Aidin Roberts
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Louise Comerford
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Catherine M Kelly
- Dept. of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Janice M Walshe
- Dept. of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Michelle Peate
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Victoria, Australia
| | - Martha Hickey
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Victoria, Australia
| | - Donal J Brennan
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
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48
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Scott AJ, Webb TL, Martyn-St James M, Rowse G, Weich S. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev 2021; 60:101556. [PMID: 34607184 PMCID: PMC8651630 DOI: 10.1016/j.smrv.2021.101556] [Citation(s) in RCA: 260] [Impact Index Per Article: 86.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 02/07/2023]
Abstract
The extent to which sleep is causally related to mental health is unclear. One way to test the causal link is to evaluate the extent to which interventions that improve sleep quality also improve mental health. We conducted a meta-analysis of randomised controlled trials that reported the effects of an intervention that improved sleep on composite mental health, as well as on seven specific mental health difficulties. 65 trials comprising 72 interventions and N = 8608 participants were included. Improving sleep led to a significant medium-sized effect on composite mental health (g+ = -0.53), depression (g+ = -0.63), anxiety (g+ = -0.51), and rumination (g+ = -0.49), as well as significant small-to-medium sized effects on stress (g+ = -0.42), and finally small significant effects on positive psychosis symptoms (g+ = -0.26). We also found a dose response relationship, in that greater improvements in sleep quality led to greater improvements in mental health. Our findings suggest that sleep is causally related to the experience of mental health difficulties. Future research might consider how interventions that improve sleep could be incorporated into mental health services, as well as the mechanisms of action that explain how sleep exerts an effect on mental health.
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Affiliation(s)
| | - Thomas L Webb
- Department of Psychology, The University of Sheffield, UK
| | | | - Georgina Rowse
- Clinical Psychology Unit, Department of Psychology, The University of Sheffield, UK
| | - Scott Weich
- School of Health and Related Research (ScHARR), The University of Sheffield, UK
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49
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Felder JN, Epel ES, Neuhaus J, Krystal AD, Prather AA. Randomized controlled trial of digital cognitive behavior therapy for prenatal insomnia symptoms: Effects on postpartum insomnia and mental health. Sleep 2021; 45:6444826. [PMID: 34850238 DOI: 10.1093/sleep/zsab280] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/04/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the effects of digital cognitive behavior therapy for insomnia (dCBT-I) delivered during pregnancy on subjective sleep outcomes, depressive symptoms, and anxiety symptoms through six months postpartum. METHODS People up to 28 weeks gestation (N=208) with insomnia were randomized to six weekly sessions of dCBT-I or standard care. We report follow-up data at three and six months postpartum. The primary outcome was insomnia symptom severity. Secondary sleep outcomes included global sleep quality and insomnia caseness. Mental health outcomes included depressive and anxiety symptom severity. We evaluated between-condition differences in change from baseline for each postpartum timepoint and categorical outcomes. RESULTS dCBT-I participants did not experience significantly greater improvements in insomnia symptom severity relative to standard care participants, but they did experience higher rates of insomnia remission and lower rates of insomnia caseness at six months postpartum. dCBT-I participants experienced greater improvements in depressive symptom severity from baseline to both postpartum timepoints, and in anxiety symptom severity from baseline to three months postpartum. The proportion of participants with probable major depression at three months postpartum was significantly higher among standard care (18%) than dCBT-I (4%, p=.006) participants; this between-condition difference was pronounced among the subset (n=143) with minimal depressive symptoms at baseline (18% vs 0%). CONCLUSION dCBT-I use during pregnancy leads to enduring benefits for postpartum insomnia remission. Findings provide strong preliminary evidence that dCBT-I use during pregnancy may prevent postpartum depression and anxiety, which is notable when considering the high frequency and importance of these problems.
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Affiliation(s)
- Jennifer N Felder
- Osher Center for Integrative Medicine, University of California, San Francisco, USA.,Department of Psychiatry, University of California, San Francisco, USA
| | - Elissa S Epel
- Department of Psychiatry, University of California, San Francisco, USA.,Center for Health and Community, University of California, San Francisco, USA
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Andrew D Krystal
- Department of Psychiatry, University of California, San Francisco, USA
| | - Aric A Prather
- Department of Psychiatry, University of California, San Francisco, USA.,Center for Health and Community, University of California, San Francisco, USA
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50
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Comparative efficacy of digital cognitive behavioral therapy for insomnia: A systematic review and network meta-analysis. Sleep Med Rev 2021; 61:101567. [PMID: 34902820 DOI: 10.1016/j.smrv.2021.101567] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 12/19/2022]
Abstract
The comparative efficacy of various approaches of digital cognitive behavioral therapy for insomnia (CBTi) is still unclear. This network meta-analysis explored the comparative efficacy of digital CBTi approaches in adults with insomnia. Four electronic databases were searched from inception to June 27, 2020. Primary outcomes were self-reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), and insomnia symptoms; these were measured using sleep diaries or valid questionnaires. A random-effects network meta-analysis in a frequentist framework was used. Fifty-four randomized controlled trials comprising 11,815 participants were included. Compared with usual care, web-based CBTi with a therapist demonstrated significantly longer TST (mean difference [MD]: 23.19 min, 95% confidence interval [CI]: 18.98-27.39 min), shorter SOL (MD: -18.76 min, 95% CI -24.20 to -13.31 min), lower WASO (MD: -31.40 min, 95% CI: -36.26 to -26.55 min), and greater SE (MD: 10.37%, 95% CI: 8.08%-12.65%). The surface under the cumulative ranking curve indicates that web-based CBTi with therapists is most likely to be ranked the highest among all treatments, and thus, this network meta-analysis suggests that such a treatment is the optimal intervention for improving sleep duration and SE as well as the reductions in SOL and WASO. PROSPERO REGISTRATION NUMBER: CRD42020171134.
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